Fusion-positive non-small cell lung carcinoma: Biological principles, clinical practice, and diagnostic implications

Based on superior efficacy and tolerability, targeted therapy is currently preferred over chemotherapy and/or immunotherapy for actionable gene fusions that occur in late-stage non-small cell lung carcinoma (NSCLC). Consequently, current clinical practice guidelines mandate testing for ALK, ROS1, NTRK, and RET gene fusions in all patients with newly diagnosed advanced non-squamous NSCLC (NS-NSCLC). Gene fusions can be detected using different approaches, but today RNA next-generation sequencing (NGS) or combined DNA/RNA NGS is the method of choice. The discovery of other gene fusions (involving, eg, NRG1, NUT, FGFR1, FGFR2, MET, BRAF, EGFR, SMARC fusions) and their partners has increased progressively in recent years, leading to the development of new and promising therapies and mandating the development and implementation of comprehensive detection methods. The purpose of this review is to focus on recent data concerning the main gene fusions identified in NSCLC, followed by the discussion of major challenges in this domain.

Automated summary

Targeted therapy is preferred over chemotherapy and immunotherapy for actionable gene fusions in late-stage non-small cell lung carcinoma (NSCLC) due to its superior efficacy and tolerability. Testing for ALK, ROS1, NTRK, and RET gene fusions is now mandatory for all newly diagnosed advanced non-squamous NSCLC patients. RNA next-generation sequencing (NGS) or combined DNA/RNA NGS is the preferred method for detecting gene fusions. Recent advancements have led to the discovery of new gene fusions, necessitating the development of comprehensive detection methods and promising therapies.